Healthcare Provider Details

I. General information

NPI: 1033974035
Provider Name (Legal Business Name): HUNTER LEE CARMON ROSAMOND RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S UNIVERSITY BLVD STE 2H
MOBILE AL
36609-7860
US

IV. Provider business mailing address

820 S UNIVERSITY BLVD STE 2H
MOBILE AL
36609-7860
US

V. Phone/Fax

Practice location:
  • Phone: 251-340-2020
  • Fax: 251-340-2067
Mailing address:
  • Phone: 251-340-2020
  • Fax: 251-340-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-328491
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: